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The Democrats’ political tsunami has a message for both parties On November 2, just one day before the midterm elections, I published my final forecast: Democrats would take back both chambers of Congress. I was right. But how wrong I was, too! Even I underestimated just how big the Democratic victory would be. Let’s start with what I got right I predicted a huge Democratic victory in the House. In my last forecast, I had Democrats winning somewhere between 235 and 245 seats. While the final numbers will end up higher than my high-end forecast, I clearly predicted a huge margin for Democrats in the lower chamber. As of Thursday, November 5, the latest results show Democrats with approximately 253 seats to Republicans’ 155, with 27 races still undecided. That is already an almost 40-seat net gain, and there is still room for the Democratic margin to grow. I also

The polls now point to Democrats easily taking the House and more likely than not to take the Senate Back on October 8, I told you that Democrats would easily take the House and their margins there were growing. However, I still said that the Senate was 50-50, with the GOP likely to have 50 or 51 seats and control the chamber because the White House is Republican. Now, we are here for the last update for the midterms. And the math looks increasingly daunting for the GOP perhaps to keep any chamber. Coming out of the summer political doldrums, the Democrats have maintained the edge as affordability, the war, and energy costs are top of mind for voters. The GOP at a disadvantage As I have said in past blogs on the midterms, the GOP has a huge uphill battle to keep control of both chambers. I looked at

The GOP fundamentally misread affordability issues, in particular on healthcare The midterms are Tuesday, November 3. I will offer my final House and Senate predictions Monday, the day before Americans finish voting. But following my earlier election forecast and debt blogs, I wanted to examine an issue that could help determine the outcome: healthcare affordability. Healthcare is playing an outsized role, both independently and within the broader affordability debate. The polling increasingly explains why Republicans should be worried. The polls tell a clear story United States of Care’s (USofC) People’s Health Care Survey finds that 76% of registered voters consider healthcare one of their top three voting issues. Fifty-six percent say healthcare is unaffordable, while 73% feel frustrated, overwhelmed, or helpless about costs. Only 42% of people with employer coverage report satisfaction with their insurance, compared with 66% of Medicare enrollees. Healthcare policy group KFF’s October polling reinforces the point.

Just after the Centers for Medicare and Medicaid Services (CMS) issued Star Year (SY) 2027 results, we got some new lawsuits attacking the agency’s calculations, in part related to the favorable treatment obtained again by Clover Health. So, it was time for a comprehensive update on SY 2026 and SY 2027 litigation. I have tried to keep the updates short and cogent, but Stars is not that at all right now. Where we stand on litigation We have seven total plans suing CMS for SY 2026 and/or SY 2027. A total of 9 lawsuits, not counting CMS’ appeal of Clover. We had four 2026 Stars measure lawsuits — Clover, Elevance, Scan, and Alignment. We now have five 2027 Stars measure lawsuits — Alignment, Healthfirst, Centene, Scan, and Aetna. Alignment and Centene filed in the same Georgia southern district as Clover did. Healthfirst filed in a New York district court. SY

CMS is proposing reforms to address longstanding problems with Medicare Advantage and pharmacy benefit managers The Consolidated Appropriations Act of 2026 included several provisions that could meaningfully improve transparency and accountability in Medicare Advantage (MA) and Medicare Part D. The Centers for Medicare and Medicaid Services (CMS) has now proposed regulations to implement them. I support these changes. They address problems that have persisted for far too long, and they reinforce a principle I have argued repeatedly: healthcare organizations should be accountable for the value they deliver to members. MA must get Its networks right I have long supported MA. It offers millions of seniors coordinated care, additional benefits, and quality alternatives to traditional Medicare. But supporting MA does not mean ignoring its shortcomings. Provider directories and network accuracy have been problems for decades. Members choose plans based on whether their physicians, hospitals, and other providers participate. When that information

While few are talking about it, America’s debt crisis is perhaps the most important issue out there now and for future generations. The United States has crossed $40 trillion in gross federal debt, bond investors around the world are demanding the highest yields in a quarter century, and the political class is behaving as if nothing is wrong. Too harsh? Read on and you will see why this is perhaps the most important issue facing voters this election cycle. I believe a fiscal reckoning is on the horizon. The warning signs are clear from a series of bond events we have just witnessed. A budget director’s vantage point. As a former state budget director and management secretary, I have spent a career reading budgets the way a physician reads a medical chart: looking past the headline number to the underlying vital signs. A state, unlike Washington, D.C, cannot print money,

Will MA have yet another rate headache with the GUARD and GLOBE models? I have been a major proponent of President Donald Trump’s GUARD and GLOBE drug pricing models for Medicare Part D. More than any president, Trump has really made great traction on drug pricing. Of course, critics poke holes in the myriad of reforms. I have some questions too, such as why brand drug makers agreeing to other drug price deals with Trump should be exempt from these MFN programs. But on balance, the movement is important to finally get our arms around the ongoing surge in drug prices. Yes, I admit the Biden administration took steps with the Medicare drug price negotiations. But it is ironic that a Republican administration now has done more than any administration to pursue real reform. Today’s blog, though, covers a concern Medicare Advantage (MA) plans should have about how GUARD and

Plans’ Star ratings stabilized a bit but challenges remain Thursday night saw the release of Star Year (SY) 2027 quality performance results for the Medicare Advantage industry, and the news was again not good. For all practical purposes, we are in the fifth year now of poor results coming out of the COVID pandemic and a peak in SY 2022. We did have some notable gainers, who recovered from years of Star doldrums. But other big players saw considerable declines. All things said, the industry was basically flat. The results add to the challenges plans have with declining risk adjustment revenue and rates that are not keeping up with utilization trends. A high-level barometer look I like to look at three figures the minute results are released. They tend to encapsulate the whole picture. The data throughout this blog compares SY 2027 results to the recalculated “better of” ratings announced

Coming out of summer, Democrats look well placed to possibly take both chambers As the midterms approach, I always give you a fresh look at what could happen in terms of control of Congress. Back on August 31 I did my last forecast. A great deal has changed. I told you that summer election polling is notoriously unreliable. There is a lack of engagement during the summer months by voters. Such polls also usually hit registered voters instead of likely voters. And, history would show that summer polls appear to be biased toward Democrats, consistently overestimating support for the party. Polls begin to become more accurate post Labor Day as polling switches to likely voter concentration and voters become more engaged. The problem for Republicans, though, is that the latest polls appear to be saying the same thing they did prior to Labor Day. There is some evidence that GOP

The CMS headline is stability. The details say another tough year for members and plans. The Centers for Medicare and Medicaid Services (CMS) wants you to see Medicare Advantage (MA) in 2027 as a story of lower premiums and steady choice. In its Sept. 28 release, CMS projected that the weighted average monthly MA premium would fall from $14.37 to $12, a 16.5% drop, and that the average Part D premium inside MA drug plans would fall 38%, from $11.32 to $7. The industry tells a different story. Once you open the landscape and crosswalk files, I think the industry has it right. Stability on top, churn underneath The total number of MA plans barely moves, from 5,553 in 2026 to 5,532 in 2027. But that net number hides a lot of adds and cuts. The average beneficiary will have 28 MA-PD options, down from 32. MA-PD products will fall